Medical Mycology Updates – February 2026.

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Diagnostics, molecular testing, biomarkers and stewardship

Recent publications continue to show rapid progress in molecular fungal diagnostics, particularly polymerase chain reaction (PCR), metagenomic sequencing, and digital PCR approaches. Biomarkers such as galactomannan and (1,3)-beta-D-glucan remain important tools but require careful interpretation in specific patient groups. A number of studies also emphasise laboratory stewardship and surveillance, especially for Candida auris.

Contents

1. Molecular Diagnostics and Sequencing

Targeted next-generation sequencing improves aspergillosis diagnosis

A multicentre study assessed targeted next-generation sequencing from bronchoalveolar lavage combined with host risk factors to diagnose invasive pulmonary aspergillosis in non-neutropenic patients. Integrating molecular detection with clinical risk factors improved diagnostic accuracy compared with standard methods alone.
PubMed: PMID 41769345

Metagenomic sequencing increases pathogen detection in pulmonary infections

Multiple studies evaluated metagenomic next-generation sequencing (mNGS) from bronchoalveolar lavage fluid or blood in patients with pulmonary infection. Sequencing consistently detected more pathogens than conventional culture, particularly in immunocompromised hosts.
PubMed: PMID 41457488

Metagenomic sequencing identifies complex mixed infections

A case study in a lymphoma patient showed mNGS identifying Rhizopus microsporus, Aspergillus fumigatus, Pneumocystis jirovecii and cytomegalovirus simultaneously. Conventional diagnostics had detected only a subset of these pathogens.
PubMed: PMID 41723970

CRISPR-based assay for Cryptococcus detection

Researchers developed a recombinase polymerase amplification and CRISPR-Cas12a diagnostic assay for rapid detection of Cryptococcus neoformans. This approach may enable rapid point-of-care diagnostics.
PubMed: PMID 41661284

Droplet digital PCR improves diagnosis of fungal keratitis

A duplex droplet digital PCR (ddPCR) assay significantly improved sensitivity compared with conventional PCR when detecting Aspergillus and Fusarium in keratitis.
PubMed: PMID 41554424

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2. Biomarkers in Fungal Infection Diagnosis

Sequential galactomannan may predict outcomes in invasive aspergillosis

Analysis of registry data showed that changes in serum galactomannan levels over time correlated with treatment response and clinical outcomes.
PubMed: PMID 41386396

Automated beta-D-glucan assay improves laboratory workflow

A study evaluating an automated chemiluminescent (1,3)-beta-D-glucan assay reported diagnostic performance comparable to existing assays with improved laboratory automation.
PubMed: PMID 41733444

Bacterial bloodstream infection can cause false-positive beta-D-glucan

Researchers demonstrated that bacteremia may trigger false positive beta-D-glucan results, highlighting the importance of interpreting biomarkers within clinical context.
PubMed: PMID 41273933

Galactomannan testing in COPD patients

A study evaluated sputum galactomannan testing for invasive pulmonary aspergillosis in chronic obstructive pulmonary disease patients, suggesting a potential non-invasive diagnostic option.
PubMed: PMID 41803989

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3. Candida Diagnostics and Candida auris Surveillance

PCR assays enable rapid Candida auris detection

A real-time PCR assay was developed for rapid identification of Candida auris, a multidrug-resistant pathogen associated with healthcare outbreaks.
PubMed: PMID 41765494

Automated surveillance workflows for Candida auris

Researchers evaluated automated PCR workflows combining commercial and in-house assays to improve screening of colonisation samples.
PubMed: PMID 41664521

Optimising screening strategies for Candida auris

A prospective study evaluated screening protocols for detecting Candida auris colonisation following hospital transfer from endemic wards.
PubMed: PMID 41689416

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4. Aspergillus Diagnostics and Clinical Context

Updated diagnostic criteria for invasive pulmonary aspergillosis

A retrospective analysis evaluated incidence and outcomes of invasive pulmonary aspergillosis using updated EORTC/MSG and ICU-specific diagnostic criteria.
PubMed: PMID 41809990

Mycological testing in burn patients

Researchers evaluated microscopy, culture, species-specific PCR and galactomannan for diagnosing invasive mould infections in patients with severe burns.
PubMed: PMID 41641958

Longitudinal mycological profiling in viral pneumonia-associated aspergillosis

Serial galactomannan testing in influenza- and COVID-associated pulmonary aspergillosis provided insight into disease progression and outcomes.
PubMed: PMID 41508132

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5. Laboratory Capacity and Diagnostic Stewardship

Over-testing of galactomannan adds cost without improving diagnosis

A study evaluating galactomannan use in haematology patients found that excessive testing generated substantial cost with limited clinical benefit, emphasising the importance of diagnostic stewardship.
PubMed: PMID 41621371

Survey of clinical mycology laboratories

A survey of Australasian laboratories found widespread access to galactomannan and PCR diagnostics, but limited availability of beta-D-glucan testing.
PubMed: PMID 41781254

Diagnostic capacity for fungal infections remains uneven globally

A national survey in Colombia highlighted significant gaps in laboratory capacity and antifungal access.
PubMed: PMID 41192549

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6. Notable Diagnostic Case Reports

Cryptococcal meningitis despite negative initial CSF testing

A case report described cryptococcal meningitis in an immunocompetent patient where initial cerebrospinal fluid tests were negative, with diagnosis confirmed later by culture and PCR.
PubMed: PMID 41822602

Pulmonary cryptococcosis detected by sequencing

Targeted metagenomic sequencing identified Cryptococcus neoformans in bronchoalveolar lavage fluid from an immunocompetent child with a mediastinal mass.
PubMed: PMID 41810234

ABPA without asthma

A case report demonstrated allergic bronchopulmonary aspergillosis occurring in a patient without asthma, highlighting diagnostic variability.
PubMed: PMID 41704809

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7. Key Themes from February 2026

  • Molecular diagnostics are expanding rapidly: PCR, digital PCR and sequencing technologies are increasingly used in clinical diagnostics.
  • Biomarkers remain essential but imperfect: galactomannan and beta-D-glucan continue to be widely used but require careful interpretation.
  • Candida auris surveillance is intensifying: multiple studies address improved screening methods and infection control.
  • Integration of diagnostics with stewardship: laboratories are increasingly focusing on targeted test use and antifungal stewardship.